[en] [en] PURPOSE: To describe the frequency and characteristics of intraretinal and subretinal fluid in nonarteritic anterior ischemic optic neuropathy (NAAION) and to assess the influence on the visual deficit and optic nerve fiber/ganglion cell loss.
DESIGN: A retrospective, single-center study.
PARTICIPANTS: Thirty-two patients with NAAION referred to our Neuro-ophthalmology Department between 2014 and 2021.
METHODS: The study was carried out at the University Hospital of Liège, Belgium. For participants in whom subretinal fluid was identified on standard OCT (Carl Zeiss Meditec) an additional macular OCT (Spectralis Heidelberg) had been performed. The pattern and the maximal height of the retinal fluid were determined manually, and thicknesses of retinal layers were obtained using the OCT protocol analysis.
RESULTS: The mean age of the cohort was 60 years (standard deviation, ±12.5; range, 22-88 years), and 65.6% were male. In the 21 eyes (46.7%) in which retinal fluid was observed, macular OCT findings were categorized according to fluid localization: 19 cases had parafoveal fluid (of whom 9 also had subfoveal fluid). One patient had subfoveal fluid alone, and 1 patient had peripapillary subretinal fluid alone. Specific patterns of optic disc (OD) swelling were associated with the occurrence and distribution of retinal edema. Visual acuity, visual field loss, and foveal thresholds were stable over the period of observation (P = 0.74, P = 0.42, and P = 0.36, respectively). No difference was found in visual function at 6 months between patients with retinal fluid treated (n = 10) or not treated (n = 11) with corticosteroids (visual acuity, P = 0.13; foveal threshold, P = 0.59; mean deviation, P = 0.66).
CONCLUSIONS: Subretinal fluid is found in a high proportion of cases of NAAION. Visual function remained largely stable from presentation in this cohort. Corticosteroid intake at presentation did not influence visual recovery or timing of the resorption of tissue edema. Our findings do not support treatment of NAAION with corticosteroids with or without evidence of subretinal fluid acutely. With regard to pathogenesis, we propose that the volume of transudate generated at the OD is the critical factor rather than dysfunction of retinal mechanisms subserving reabsorption.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Disciplines :
Ophthalmology
Author, co-author :
Chapelle, Anne-Catherine ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'ophtalmologie
Rakic, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Ophtalmologie
Plant, Gordon T ; Department of Neurodegeneration and Rehabilitation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
Language :
English
Title :
The Occurrence of Intraretinal and Subretinal Fluid in Anterior Ischemic Optic Neuropathy: Pathogenesis, Prognosis, and Treatment.
The authors thank Professor Anthony Arnold for his comments on our earlier draft. Obtained funding: N/A; Study was performed as part of regular employment duties at CHU Liège. No additional funding was provided.
Miller, N.R., Arnold, A.C., Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy. Eye 29 (2015), 65–79.
Hayreh, S.S., Anterior ischaemic optic neuropathy. II. Fundus on ophthalmoscopy and fluorescein angiography. Br J Ophthalmol 58 (1974), 964–980.
Dickersin, K., Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. JAMA, 273, 1995, 625.
Beck, R.W., Servais, G.E., Hayreh, S.S., Anterior ischemic optic neuropathy. IX. Cup-to-disc ratio and its role in pathogenesis. Ophthalmology 94 (1987), 1503–1508.
Rebolleda, G., Pérez-López, M., Casas-LLera, P., et al. Visual and anatomical outcomes of non-arteritic anterior ischemic optic neuropathy with high-dose systemic corticosteroids. Graefes Arch Clin Exp Ophthalmol 251 (2013), 255–260.
Demirel, S., Batıoğlu, F., Oguz, Y.G., Özmert, E., Macular involvement and response to steroid therapy demonstrated by optical coherence tomography in non-arteritic anterior ischaemic optic neuropathy. Neuroophthalmology 37 (2013), 161–164.
Takayama, K., Kaneko, H., Kachi, S., et al. High-dose intravenous pulse steroid therapy for optic disc swelling and subretinal fluid in non-arteritic anterior ischemic optic neuropathy. Nagoya J Med Sci 79 (2017), 103–108.
Carta, A., Mora, P., Aldigeri, R., et al. Optical coherence tomography is a useful tool in the differentiation between true edema and pseudoedema of the optic disc. PLoS One, 13, 2018, e0208145.
Kang, Li, Xiaodong, Wu, Chen, D.Z., Sonka, M., Optimal surface segmentation in volumetric images-a graph-theoretic approach. IEEE Trans Pattern Anal Mach Intell 28 (2006), 119–134.
Ghazi, N.G., Green, W.R., Pathology and pathogenesis of retinal detachment. Eye 16 (2002), 411–421.
Petzold, A., Fraser, C.L., Abegg, M., et al. Diagnosis and classification of optic neuritis. Lancet Neurol 21 (2022), 1120–1134.
Ishikawa, M., Sawada, Y., Yoshitomi, T., Structure and function of the interphotoreceptor matrix surrounding retinal photoreceptor cells. Exp Eye Res 133 (2015), 3–18.
Gelfand, J.M., Nolan, R., Schwartz, D.M., et al. Microcystic macular oedema in multiple sclerosis is associated with disease severity. Brain 135:Pt 6 (2012), 1786–1793.
Abegg, M., Dysli, M., Wolf, S., et al. Microcystic macular edema: retrograde maculopathy caused by optic neuropathy. Ophthalmology 121 (2014), 142–149.
Kim, D.H., Shin, G.R., Choi, Y.J., Risk factors for non-arteritic anterior ischaemic optic neuropathy in a Korean population. Neuro-Ophthalmology 41 (2017), 68–75.
Hayreh, S., Podhajsky, P., Zimmerman, M.B., Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 213 (1999), 76–96.
Hayreh, S.S., Role of nocturnal arterial hypotension in the development of ocular manifestations of systemic arterial hypertension. Curr Opin Opthalmol 10 (1999), 474–482.
Finger, M.L., Borruat, F.X., Dynamics of intraretinal fluid accumulation evidenced by SD-OCT in a case of cat scratch neuroretinitis. Eye 28 (2014), 770–771.
Ozdemir, H., Karacorlu, M., Karacorlu, S., Serous macular detachment in central retinal vein occlusion. Retina 25 (2005), 561–563.
Pizzimenti, J.J., Daniel, K.P., Central serous chorioretinopathy after epidural steroid injection. Pharmacotherapy 25 (2005), 1141–1146.
Dinc, U.A., Yenerel, M., Tatlipinar, S., et al. Correlation of retinal sensitivity and retinal thickness in central serous chorioretinopathy. Ophthalmologica 224 (2010), 2–9.
Moura, F.C., Sato, D.K., Rimkus, C.M., et al. Anti-MOG (myelin oligodendrocyte glycoprotein)–positive severe optic neuritis with optic disc ischaemia and macular star. Neuro-Ophthalmology 39 (2015), 285–288.
Otani, T., Kishi, S., Tomographic findings of foveal hard exudates in diabetic macular edema. Am J Ophthalmol 131 (2001), 50–54.
Kitamei, H., Kitaichi, N., Namba, K., et al. Clinical features of intraocular inflammation in Hokkaido, Japan. Acta Ophthalmologica 87 (2009), 424–428.
McCulley, T.J., Lam, B.L., Feuer, W.J., Nonarteritic anterior ischemic optic neuropathy and surgery of the anterior segment: temporal relationship analysis. Am J Ophthalmol 136 (2003), 1171–1172.
Wostyn, P., De Groot, V., Van Dam, D., et al. The glymphatic system: a new player in ocular diseases?. Investig Ophthalmol Vis Sci 57 (2016), 5426–5427.
Petzold, A., Retinal glymphatic system: an explanation for transient retinal layer volume changes?. Brain 139 (2016), 2816–2819.
Balk, L.J., Killestein, J., Polman, C.H., et al. Microcystic macular oedema confirmed, but not specific for multiple sclerosis. author reply e227 Brain, 135(Pt 12), 2012, e226.
Masri, R.A., Weltzien, F., Purushothuman, S., et al. Composition of the inner nuclear layer in human retina. Invest Ophthalmol Vis Sci, 62, 2021, 22.
